5^th Asia Pacific Gynecology and Obstetrics Congress August 22-23, 2018 Tokyo, Japan

Dr Ho Yau Bong is an Associate Consultant and Team Leader of Assisted Reproductive Technology Unit in United Christian Hospital in Hong Kong. He has performed a wide range of fertility surgeries, advanced laparoscopic surgeries and advanced hysteroscopic surgeries including laparoscopic myomectomy and total laparoscopic hysterectomy for complex cases

This case illustrates the importance of having active gynaecological intervention for patients with sudden onset of anti-NMDA receptor encephalitis with the presence of ovarian dermoid cysts. A 18-year-old Chinese lady was presented with acute onset of confusion, development of unsteady gait, slurring of speech and gradual deterioration of Glasgow Coma Scale. Lumbar puncture was performed and cerebrospinal fluid revealed mild leukocytosis and a slight elevation in protein. CT and MRI brain, septic workup and toxicology screening were all normal. Patient was treated as viral meningoencephalitis with Acyclovir and Antibiotics. Nevertheless, she developed episodes of tonic-clonic seizures requiring intubation and admission to Intensive Care Unit. Serum auto-antibody titre was checked and anti-NMDA receptor antibody was positive. Diagnosis of anti-NMDA receptor antibody encephalitis was made. She was treated with Prednisolone, plasmapheresis, IVIG and Rituximab. CT abdomen and pelvis scan revealed a 4x3x2cm right ovarian teratoma. Emergency laparoscopic right ovarian cystectomy was done and histology confirmed the presence of mature cystic teratoma. Her conscious level gradually improved 5 weeks after the operation and she was discharged 13 weeks afterwards. Subsequent follow-up showed she has a full recovery with no seizure nor other functional deficits. Anti-NMDA receptor antibody encephalitis was first discovered in 2007 and around half of the cases were associated with ovarian teratoma. It is thought that this condition can be caused by auto-antibodies produced by cross-reactivity with NMDA receptors in teratomas. Ovarian cystectomy can improve this condition as it can eradicate the source of auto-antibodies.

Dr MY Chan is an Associate Consultant in United Christian Hospital in Hong Kong. She has special interests in advanced laparoscopic surgery and reproductive medicine. She performed wide range of advanced laparoscopic surgery including laparoscopic myomectomy and total laparoscopic hysterectomy for large uterine sizes. She is also a trainer for laparoscopic courses in Hong Kong.

Madam Wong was a 43-year-old parity 2 woman, who had laparoscopic myomectomy performed on 25 April 2014 for a 6 x 7 cm anterior wall intramural fibroid. The fibroid was morcellated in the peritoneal cavity laparoscopically and retrieved. The uterus was 6 weeks in size after the operation. She complaint of on and off lower abdominal pain in June 2017. On physical examination, there was a 18 weeks’ size pelvic mass. Ultrasound scan showed three well defined heterogenous hypoechoic mass at the left adnexa and lower abdomen, measuring 5 x 6 x 7cm, 4 x 5 x 4cm and 5 x 8 x 8cm. Tumor markers were checked and showed an elevated Ca 125 level to 167 units/mL. A computer tomography scan was done showing a 4 cm pedunculated fibroid and two heterogenous shadow in the pelvis, both were separated from uterus, suspicious of peritoneal metastasis. USG-guided biopsy was performed on 1 December 2017 and the histology showed smooth muscle tumor. She was given Ulipristal afterwards. MRI was done one month later, showing the known three pelvic masses were decreasing in size. The provisional diagnosis was disseminated peritoneal leiomyomatosis. She finally had total abdominal hysterectomy with bilateral salpingo-oophorectomy done in March 2018. A 4x4 cm pedunculated soft tissue mass was seen arising from the back of uterus and buried in the left para-rectal space; another 10 x 10 cm soft tissue mass with cystic changes located around mid-portion of the thickened round ligament; another 4x4cm soft tissue mass was at the fundus of uterus. Frozen section showed spindle cell tumor. Bilateral fallopian tubes and ovaries were normal. The final histology showed leiomyoma, confirming the diagnosis of disseminated peritoneal leiomyomatosis. Disseminated peritoneal leiomyomatosis occurs in less than 1% of all patients who underwent a prior surgery with morcellation. It is postulated that the development of disseminated peritoneal leiomyomatosis is by seeding in various peritoneal sites and it often occurs two years after the primary surgery. Our case illustrates the importance of using in-bag morcellation of all fibroids. Not only it can avoid the spreading of a malignant tumour, but it can also avoid the occurrence of disseminated peritoneal leiomyomatosis.

Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899

Background: Uterine fibroids are common benign tumours in women. However, acute complications necessitating emergency surgical intervention are rare. We report herein a case of spontaneous rupture of uterine fibroid needing emergency laparotomy and myomectomy. Case: A 30 years old lady, nulliparous, presented to the emergency department with acute onset of lower abdominal pain for 1 day. She has medical history of hypertension and asthma. Her pregnancy test was negative. On examination, she had diffuse tenderness in the abdomen. A bedside abdominal sonogram revealed a large amount of free fluid. She was stable and went for a CT abdomen and pelvis which showed haemoperitoneum with source of bleed arising from a large uterine mass that has ruptured. The haemoglobin level initially was 11.6 g/dL. Patient went for emergency diagnostic laparoscopy. Upon entry by laparoscopy, a 9cm pedunculated subserosal uterine leiomyoma was found, with an actively bleeding vein. Decision was made to convert to open myomectomy in view of the active bleeding. The leiomyoma was excised and 1.3 liters of blood and blood clots were evacuated from the peritoneal cavity. The postoperative course was uneventful. Her postoperative haemoglobin level was 7 g/dL. The patient was given 1 U of packed red blood cells and iron injection. Histopathologic review of the specimen revealed a 9cm fibroid with haemorrhagic areas. Discussion: Acute complications secondary to fibroids are rare and seldom necessitate emergency surgical intervention. However, prompt recognition of this severe complication is critical for life-saving surgical management. Conclusion: Rupture of uterine fibroid should be included in the differential diagnosis when encountering patient with known uterine myoma and acute abdomen pain. Exploratory laparotomy is both diagnostic and therapeutic in this life threatening condition.

Dr Sunghee Lee has her expertise in research and passion in improving the health and wellbeing among women. Her special interests are in developing and evaluating policies for preventing intimate partner violence.

Purpose: The purpose of this study was to identify the effects of Objectified Body Consciousness and Self-compassion on Premenstrual syndrome among female college students and factors that influence the Premenstrual Syndrome among college student in Korea. Methods: The subjects of this study were the 525 numbers of college students in the one university and two community college in D city. Questionnaire survey was conducted from May through June, 2017. Data were analyzed using SPSS version 20.0 for descriptive statistics, t-test, one-way ANOVA. To examine influencing factors on Premenstrual syndrome, Pearson's correlation coefficient and hierarchical regression method were used. Results: On the one hand, there were positive correlations between body surveillance(r=.179, p<.001), body shame(r=.327, p<.001) and premenstrual syndrome. Also there was positive correlation between body surveillance and body shame(r=.346, p<.001). On the other hand, there were negative correlations between self-compassion(r=-.289, p<.001) and premenstrual syndrome. Also there were negative correlations between body surveillance(r=-.249, p<.001), body shame(r=-.341, p<.001) and self-compassion. There were significant differences in age, grade, sleep satisfaction, caffeine intake, family history of menstrual disorder, and history of gynecologic disease. It was found that sleep dissatisfaction, family history of menstrual disorder were the factors influence on premenstrual syndrome among college student. These variables explained about 42.6% of the variance in premenstrual syndrome. Conclusion: This research provides evidence that the higher body surveillance, the higher level of premenstrual syndrome, and the higher self-compassion, the lower level of premenstrual syndrome. Also sleep dissatisfaction and family history of menstruation disorder were the most influential factors that explain the premenstrual syndrome of college student. These findings can provide basic information on the development of a self-compassion program for female college students with premenstrual syndrome, especially with high body shame. Key words: Body image, Caffeine, Menstruation Disorders, Premenstrual syndrome, University

Jung A Kim is a doctoral student. She worked at the Kyoungpook National University Hospital Emergency Room from 2012 to 2015. She is interested in many problems of emergency room nurses. As nurses are mostly women, this is also the nature of women's career problems. Improving the working environment of the nurse can help provide better nursing to the patient. She wants people to be interested in this problem.

This study was aimed at investigating the effect of violence experience and self compassion of the post-traumatic stress disorder(PTSD) working in emergency department nurses. Violence experience is a physical violence that involves threats or intimidation, physical threats such as kicking or attempting to swig a fist, and physical violence experiences, such as throwing, kicking, or knocking objects. PTSD is a mental disorder that occurs after experiencing a serious injury or an event that threatens the physical well-being of an individual, and experiences severe feelings of fear, helplessness, and fear, thereby seriously affecting interpersonal and occupational functioning. Self-compassion is an attitude of caring for oneself with mercy in the case of suffering of failure. Violence experience, self-compassion, and post-traumatic stress disorder were measured using a structured questionnaire among 96 nurses in the emergency departments located in D and G cities in South Korea from June to July of 2017. The collected data were analyzed by using IMB SPSS Statistics version 20.0. Also, correlations among violence experience, subfactor of self compassion, and post-traumatic stress disorder were examined by Pearson's correlation coefficient. To examine influencing factors on post-traumatic stress disorder, hierarchical regression method used. In this study, the physical threat experience has a significant effect on the post-traumatic stress disorder and the explanatory power of post-traumatic stress disorder is increased(β=.383, p<.001). Self kindness showed a negative correlation with post-traumatic stress disorder(r=-.392, p<.001). Particularly, self kindness, which is a subfactor of self compassion, has a significant effect on post-traumatic stress disorder and the explanatory power of post-traumatic stress disorder is decreased(β=-.365, p<.001). It suggests that, when developing intervention programs for post-traumatic stress disorder in emergency department nurses, physical threats and self kindness should be taken into consideration.

Hoon Jung Jeon is a part-time lecturer of the College of Nursing at Kyungpook National University. She is a Acute Care Nurse Practitioner. The dysmenorrhea, the irritable bowel syndrome and the women health care are interested

Purpose: The purpose of this study is to identify predictive factors to affect the severity of dysmenorrhea of Korean female college students. Methods: The participants were 761 female college students in three universities in D city. Data collection was performed from May to June, 2017 through face-to-face interviews with four researchers using structured questionnaires and Google online surveys. The data were analyzed using the multiple logistic regression analysis with the SPSS version 20.0 to identify predictive factors of severity of dysmenorrhea. Results: Biological and behavioral factors, and self-compassion were all included to find out the predictive factors on severity of dysmenorrhea. The zero-hypothesis would be rejected because the fit of the model was χ² = 169.466 (p <.001) and the total coefficient excluding the constant value is zero. According to the age of the subcategories of biological factors, the mild dysmenorrhea is more increased 1.74 times (AOR 1.74, CI 1.01 ~ 3.01, p <.048) at 21-22 years and the moderate dysmenorrhea is more increased 16.23 times (AOR 16.23, CI 1.89 ~ 139.47, p <.011) at over 25 years than under 20 years. On the amount of menstrual, the mild dysmenorrhea was 8.53 times (AOR 8.53, CI 1.75 ~ 41.58, p <.008) and the moderate was 16.07 times (AOR 16.07, CI 3.20 ~ 80.61, p <.001) more increased respectively than the low amount of menstrual. As to the family history of menstrual disorders, mild dysmenorrhea was 2.49 times (AOR 2.49, CI 1.37 ~ 4.53, p <.003) and the moderate of dysmenorrhea was 6.48 times (AOR 6.48, CI 3.50 ~ 12.02, p <.001) more increased respectively than no family history. According to the sleep satisfaction as the subcategories of behavioral factors, the moderate dysmenorrhea is more increased 2.78 times (AOR 2.78, CI 1.24 ~ 12.02, p <.013) than they were dissatisfied with sleep. When a point of self-compassion is decreased, the mild dysmenorrhea was 0.96 times (AOR .96, CI .92 ~ .99, v <.030) and the moderate dysmenorrhea was 0.94 times (AOR 0.94, CI ~ .90. 98, v <.004) more increased. Conclusions: The results of this study demonstrated that biological and behavioral factors, and self-compassion were the predictive factors on the degree of dysmenorrhea of female college students. According to this study, it would help to predict the high risk group on dysmenorrhea in clinical area and it provides basic data to develop future nursing interventions on improving self-management of dysmenorrhea patients.

Lingling Salang is certified in Reproductive Medicine as well as Obstetrics and Gynecology. She has practiced as specialists in reproductive medicine, infertility and endoscopy surgery in Khon Kaen University, Khon Kaen, Thailand. Her views her role as a fertility specialist consultant in individualized patient care. She has built this model after years of experience in research, evaluation, teaching and administration both education institutions and in hospital.

Statement of the problem: A few studies have been published on the outcome of pregnancy among patients with Systemic Sclerosis (SSc) but to our knowledge none among Thai patients with SSc. Our objective was to determine the pregnancy outcome among Thai patients with SSc. Methodology & Theoretical Orientation: A 11-year retrospective study (between 2007 and 2017) was conducted at Srinagarind Hospital, Khon Kaen University. All pregnant women with SSc were enrolled to evaluate their pregnancy outcomes. Findings: Seven pregnancies from 5 women with SSc were reviewed. The pregnant women were between 23 and 37 years. Four of the 5 had the limited cutaneous SSc subset and two had overlap with other connective tissue diseases. Only 1 patient had pulmonary fibrosis before being pregnant but she continued the pregnancy without any worsening of the disease. Four of seven SSc pregnant participants required pregnancy termination for uncontrolled autoimmune hemolytic anemia, eclampsia with hemolytic elevated liver enzyme and low platelet (HELLP), fetal distress, and premature rupture of membrane, respectively. The pre-term delivery occurred in 2 pregnant SSc patients and the maternal and fetal outcomes were normal. Conclusion & Significance: The number of pregnant SSc patients in the 11-year historical review was limited previously studied. Most of patents had an uncomplicated pregnancy but the respective maternal and fetal outcome in those with SSc overlap with other connective tissue disease trended to be worse than in pure SSc. Family planning is suggested for all reproductive age SSc patients.